Table 3.

Literature on drug-induced REM behavior disorder (RBD) ordered by publication date.

Area shaded gray is the key for Table 3

Reference—Drug, Dosage Used
• Drug mechanism of action	• Other medications	Number of patients evaluated, Age, Sex	PSG documenting PLMS	Co-morbid condition
		Tobacco use evaluated
• T1/2, Tmax	• Treatment for RBD → Response to treatment	Caffeine use evaluated	PSG documenting OSA	Clinical Manifestations of RBD present
Timing of medication dosage		Alcohol use evaluated
Akindele et al. 197056—Phenelzine, 45-60 mg/day
• Monoamine oxidase inhibitor	Patients A and B: nialamide Rest of the patients: unknown	7; Patients A, B, F, G are “young adults” and are all male. Patients M, R, K have a mean age of 47 and are all female.	PLMS not mentioned	A, B, F, G: normal M, R, K: psychiatric
		No
11 h, 43 min	• Discontinuation of phenelzine → RSWA ceased	No	Sleep disordered breathing not mentioned	G, F, M: had vivid dreams All 7 patients had RSWA.
Unknown		Yes. Patients had no alcohol use.
Guilleminault et al. 197627—Clomipramine, 100 mg/day
• Tricyclic antidepressant Inhibits re-uptake of serotonin	• 17/21 patients were on methylphenidate and/or amphetamine	21, mean age 37, 10 male	PLMS not mentioned	Narcolepsy
		No
• 19-37 h, 2-6 h	• Discontinuation of clomipramine → effect on RSWSA unknown	No	• Sleep disordered breathing not mentioned	No
• 25 mg QID, 8 AM, 12 PM, 3 PM, 5 PM		No
Besset 197874—Clomipramine, 100-175 mg/day
Tricyclic antidepressant Inhibits re-uptake of serotonin	• Unknown	7, mean age unknown, age range 20-25, 5 male	PLMS not mentioned	Normal
		No
• 19-37 hours, 2-6 hours	• Discontinuation of clomipramine → effect on RSWA unknown	No	Sleep disordered breathing not mentioned	No
• Unknown		No
Bental et al. 197972—Clomipramine, 75 mg/day
Tricyclic antidepressant Inhibits re-uptake of serotonin	Unknown	1, 52, female	PLMS not mentioned	Narcolepsy
		No
• 19-37 hours, 2-6 hours	• Decrease dosage of clomipramine → failed	No	Sleep disordered breathing not mentioned	Yes
• Unknown		No
Schenck 199273—3 of 17 patients developed RBD, Patient 12, Nortriptyline, 100 mg/day; Patient 13, Imipramine, 225 mg/day; Patient 14, Imipramine, 30 mg/day
• Tricyclic antidepressant	Patient 12: Methylphenidate 35 mg/day Patient 13: Methylphenidate 110 mg/day Patient 14: Pemoline 112 mg/day	3, mean age 41, 1 male	Yes. 10/17 had PLMS. Unknown if patient 12, 13, 14 had PLMS.	Narcolepsy
		No
• Various	• None	No	Sleep disordered breathing not mentioned	Yes
• Unknown		No
Schenck et al. 199228—SSRI: fluoxetine TCAs: amitriptyline, nortriptyline, imipramine, desipramine, protriptyline, trimipramine
SSRI TCA	2 patients with subclinical RBD on TCA: imipramine Others unknown	Total patients unknown Mean age unknown Sex distribution unknown 41 patients on fluoxetine 52 patients on TCA (amitriptyline 23, nortriptyline 8, imipramine 10, desipramine 6, protriptyline 4, trimipramine 1) One patient with RBD on fluoxetine: 32-year-old man Two patients with subclinical RBD on TCA: 32-year-old woman, 37-year-old man Other patients unknown	Yes. 15/41 patient on fluoxetine 13/52 patients on TCA Unknown whether patients with RBD or subclinical RBD had PLMS Mean age across all groups: 38	Psychiatric
		No
• Various medications	• 1 patient with RBD on fluoxetine: cessation of fluoxetine → failed	No	Yes 16/41 patients on fluoxetine 21/52 patients on TCA Unknown whether patients with RBD or subclinical RBD had OSA	Yes
1 patient with RBD on fluoxetine: fluoxetine 20 mg BID 6 patients with subclinical RBD on fluoxetine: unknown 1 patients with RBD on TCA: unknown 150 mg at bedtime		No
Niiyama et al. 199354—Clomipramine, 50 mg/day
Tricyclic antidepressant Inhibits re-uptake of serotonin	• Unknown	11, mean age 20, all male	PLMS not mentioned	Normal
		No
• 19-37 h, 2-6 h	• None	No	Sleep disordered breathing not mentioned	No
• 1 h before PSG		No
Louden et al. 199557—Selegiline, Patient 1, 5 mg/day; Patient 2-3, 10 mg/day
Monoamine oxidase type B inhibitor	Patient 1: unknown Patient 2: Carbidopa 25 mg/levodopa 100 mg BID, other medications unknown Patient 3: unknown	Three patients Patient 1: 81, male Patient 2: 60, male Patient 3: 71, female Mean age: 70	PLMS not mentioned.	Parkinson disease
		No
• Unknown	Patient 1: not evaluated Patient 2: Discontinuation of selegiline → RBD ceased Patient 3: not evaluated	No	Sleep disordered breathing not mentioned.	Yes
Patient 1: unknown Patient 2-3: twice a day		No
Carlander et al. 1996*77—Experimental acetylcholinesterase inhibitor
• Acetylcholinesterase inhibitor	• Unknown	1, 66, male	PLMS not mentioned	Alzheimer's disease
		No
• Unknown	• Discontinuation of experimental acetylcholinesterase inhibitor → RBD subsided	No	Sleep disordered breathing not mentioned	Yes
• Unknown		No
Schutte et al. 1996*58—Venlafaxine, dosage unknown
Serotonin reuptake inhibitor Norepinephrine reuptake inhibitor Dopamine reuptake inhibitor	• lithium, lovastatin	1, 59, male	PLMI: 17.	Psychiatric
		No
• 5 h, 2 h	• Addition of clonazepam → RBD ceased	No	Patient on CPAP during PSG after start of venlafaxine. Prior PSG showed AHI of 46.	Yes
Unknown		No
Iranzo et al. 199978—Bisoprolol, Patient 1, 10 mg/day; Patient 2, 2.5 mg/day
• β -adrenoreceptor antagonist	• Unknown	Patient 1: 50, female Patient 2: 56, male	PLMS not mentioned	Hypertension
		No
• 9-12 h, 2-4 h	Patient 1: Bisoprolol discontinued → RBD ceased Patient 2: Bisoprolol replaced by enalapril → RBD subsided	No	Sleep disordered breathing not mentioned	Yes
• Unknown		No
Attarian et al. 200055—Clomipramine, 75 mg/day
Tricyclic antidepressant Inhibits re-uptake of serotonin	• Unknown	1, 55, female	PLMS not mentioned	Narcolepsy
		No
• 19-37 h, 2-6 h	• None	No	Sleep disordered breathing not mentioned	Yes
• Bedtime		No
Onofrj et al. 200359—Mirtazapine, 30 mg/day
• post-synaptic 5-HT2 and 5-HT3 antagonist	Patient 1: 500 mg levodopa, benserazide Patient 2: 300 mg levodopa and carbidopa Patient 3: unknown Patient 4: 600 mg levodopa and carbidopa, benserazide	4, mean age: 72, all male	PLMS not mentioned	Parkinson disease
		No
• 20-40 h, 2 h	• Patients 1-4: Discontinuation of mirtazapine → RBD ceased	No	Sleep disordered breathing not mentioned	Yes
• Unknown		No
Winkelman et al. 200429—5 patients on fluoxetine, 25-50 mg/day; 3 patients on paroxetine, 15-40 mg/day; 3 patients on citalopram, 20-40 mg/day; 3 patients on sertraline, 100-225 mg/day; 1 patient on venlafaxine, 400 mg/day
• SSRI	2 patients on bupropion Other medications unknown	15, mean age 45, 6 male	PLMS not mentioned	Psychiatric
		No
• Various	• None	No	Patients with OSA were excluded	No
• Unknown		No
Dib et al. 200875—12 patients. Serotonergic antidepressants were evaluated. Exact medications unknown.
• SSRI	• Unknown	12, age range: 40-60, all male	PLMS not mentioned	Unknown
• Various	• None	No	Sleep disordered breathing not mentioned	Unknown. Tonic EMG activity was significantly more in drug group than in control group.
• Unknown		No
		no

^*Reference is a published abstract (Carlander 1996, Schutte 1996).

TCA, tricyclic antidepressants; SSRI, selective serotonin reuptake inhibitors; Subclinical RBD in Schenck 1992 is defined as increased electromyogram tone in REM with no specific clinical correlates; PLMI, periodic limb movement index; AHI, apnea hypopnea index; QID, four times a day; PLMS, Periodic limb movements of sleep; OSA, obstructive sleep apnea; TCA, tricyclic antidepressants; RSWA, REM sleep without atonia; Tmax, time to maximum serum concentration; T1/2, serum half-life.